The first thing children do when they arrive at The Children's Center at Carolina Park is walk to the sink and wash their hands, Director Chris Marino said.
Watch a small child for a few minutes, and you'll watch their hands get dirty. They put toys in their mouths. They touch the floor and suck their fingers.
"Just think about kids and all the surfaces they touch in day care," said Angela Fraser, associate professor of food science and human nutrition at Clemson University.
Fraser received a $570,000 grant to do just that — study child care centers to learn about food-borne microbes that cause illnesses. She is the principal investigator for a three-year study that will observe 100 licensed child care facilities in North and South Carolina.
Researchers are still identifying the centers where they will observe food handling, hygiene and sanitation practices of child care workers. They also will take microbe samples from hands and surfaces.
"Anytime you're around a lot of people, you're more prone to get sick," Fraser said. Add to that equation toddlers and infants who don't know how to use the toilet, and risk increases.
The Children's Center has 250 students ages 6 months to 5 years old, Marino said. Hand washing is paramount. Before snack, after snack, after playground, after bathroom — the children at the center are trained to wash their hands.
"For little children, especially, that's the No. 1 way to keep them from spreading germs," Marino said.
Children in day care are three times more likely to catch a bacteria or virus that causes gastrointestinal symptoms such as vomiting, diarrhea, fever and nausea, according to Fraser. And children under age 5 are at higher risk of suffering complications related to those illnesses, such as hospitalization, dehydration and even death.
"The ultimate goal is to reduce food-borne illness in day care, not to be punitive, but help child care become a safer place," Fraser said.
Dr. Robert Ball, an epidemiologist at the S.C. Department of Health and Environmental Control, said that during the winter, health officials receive reports of one to two clusters per week of intestinal viruses at various types of facilities, including day care and nursing homes.
By and large, Ball said, the most common culprits are noroviruses, which can cause acute gastrointestinal problems. In a day care setting, the virus is passed mainly through fecal-oral transmission, when an infant touches a dirty diaper and then touches his face or another's face or toy.
Fraser said, "It has a lot to do with, we believe, the unintentional contamination of surfaces."
Fraser will be working with food-safety experts Sheryl Cates of the Research Triangle Institute in Durham, N.C., and Lee-Ann Jaykus of N.C. State University in Raleigh. The research project's findings will be used for training child care workers.